Medicare attack ads surface despite little chance of changes

Democratic Senate candidate Alison Lundergan Grimes, who is challenging Senate Minority Leader Mitch McConnell in Kentucky, repeatedly has sidestepped questions about whether she would have voted for the Patient Protection and Affordable Care Act.

But the Grimes' campaign last month released a 60-second TV ad featuring her grandmother discussing the debilitating effects of her husband's stroke.

Grimes appears and says: “This is why we have to strengthen Medicare. Sen. McConnell's voted over and over again to raise seniors' Medicare costs. I'll never do that.”

Medicare is surfacing often in attack ads like this in the final campaign push leading up to the Nov. 4 congressional elections. In recent weeks, it also has been the subject of ads in tight Senate contests in Alaska, Arkansas, Iowa and Louisiana. Those are among the races that will determine which party controls the Senate in 2015—and how much power congressional Republicans will have in wrangling with the Obama administration over the ACA and other healthcare issues.

But many experts question whether either party will seriously pursue major changes in the popular program after the election, no matter who controls the Senate. The endless war over Obamacare has discouraged many elected officials from taking on another bloody healthcare fight. Most observers don't expect that to change after Election Day, even though many Republicans see privatizing Medicare and capping its spending as central to their agenda.

“I just can't imagine that Congress will want to get into the really controversial stuff,” said John Rother, a former senior AARP official and current president of the National Coalition on Health Care, a nonpartisan advocacy group. “That sense of urgency that we have to do something to keep the program alive is not nearly as intense as before.”

Over the past several years, congressional Republicans, led by House Budget Committee Chairman Paul Ryan of Wisconsin, repeatedly have proposed major structural changes in Medicare, including paying seniors a fixed amount to select among private plans or traditional Medicare, raising the eligibility age and charging higher means-tested premiums.

President Barack Obama's most recent budget proposal included more than $400 billion in reduced spending on Medicare over a decade. That included $53 billion in increased premiums for higher-income beneficiaries and $117 billion from requiring drugmakers to give rebates on prescription drugs to low-income beneficiaries on Medicare and Medicaid.

In addition, various groups and experts have proposed other changes such as revamping beneficiary cost-sharing and the rules for supplemental coverage, expanding competitive bidding and allowing the CMS to negotiate lower drug prices.

While a major overhaul of Medicare looks unlikely in 2015, there are areas of possible action. If Democrats retain control of the Senate, Rother predicts Senate Finance Committee chairman Ron Wyden (D-Ore.) will push during the lame-duck session for permanent repeal and replacement of the Medicare sustainable growth-rate physician pay formula. In March, Congress passed a one-year patch—the 17th straight short-term fix—to avoid significant decreases in physician payments.

But others are skeptical, particularly given the difficulty in getting bipartisan agreement on how to pay for the expensive fix. “That seems unlikely,” said Dr. Mark McClellan, who served as CMS administrator under President George W. Bush and is now a senior fellow at the Brookings Institution. “It's tough to get big legislation done in a lame-duck session.”

Even if the Republicans win the Senate, McClellan doubts Congress will be able to push through major Medicare changes such as Ryan's proposed “premium support” plan as long as Obama is president. Still, McClellan thinks there could be a few significant changes, such as expanding the Medicare accountable care and bundled payment initiatives and increasing means testing of Medicare premiums. “Even if you don't get all the way to the Ryan plan, there's a good opportunity for Republicans to make incremental progress in that direction,” McClellan said.

Another possible area of bipartisan agreement if Democrats retain Senate control is Wyden's Better Care, Lower Cost Act, co-sponsored by Sen. Johnny Isakson (R-Ga.). That proposal aims to save money by better coordinating care for Medicare beneficiaries with multiple chronic conditions. The bill has bipartisan support in the House.

A big factor driving more sweeping Medicare overhaul proposals has been the rapidly rising cost of the Medicare program. But now, while the program faces long-term fiscal problems because of a huge number of baby boomers who are surging into it, per capita spending growth has slowed significantly, lessening the pressure to take action. Per-beneficiary spending grew by 0.3% in 2012 and was flat in 2013, according to the 2014 Medicare Trustees' report. The Part A hospital trust fund now is expected to remain solvent through 2030—13 years longer than before the ACA was passed.

Despite the improbability of a Medicare overhaul after the election, congressional candidates are invoking Medicare as an issue this fall because seniors make up a disproportionate share of the voters in mid-term elections when overall turnout is low.

“It's a midterm, (so) you're talking to 50-plus voters,” said Jim Cauley, a Kentucky political operative who ran Democratic Gov. Steve Beshear's gubernatorial campaign in 2007. “Medicare affects their lives.”

Democrats are using Medicare as a campaign issue more aggressively than Republicans, a contrast with the 2010 elections when Republicans had success blasting Democrats for supporting the ACA's Medicare spending curbs. In the first half of September, one in five Democratic ads mentioned Medicare or Social Security, according to Kantar Media CMAG, a nonpartisan media monitoring organization. By comparison, just one in 10 GOP ads mentioned the senior programs.

But some observers question the effectiveness of some of the ads. Stephen Voss, a political science professor at the University of Kentucky, said Grimes' ad with her grandmother was a dud. “That particular ad really shows the limits of trying to make coherent political arguments in one minute,” he said.

In recent elections, Republicans have had the upper hand with senior voters. Presidential candidate Mitt Romney received support from 56% of voters age 65 and older in 2012, up from 53% for John McCain in 2008. In 2010, which saw Republicans win 63 House seats and control of the chamber, 59% of seniors backed GOP House candidates, according to CNN.

There are some indications, however, that Democrats are doing better with seniors this time around. A Kaiser Health Tracking poll conducted in August and September found that registered voters 65 and older were evenly split over whether Democrats should keep control of the Senate, although Republicans held a five-point edge among likely voters. Some observers attribute the apparent Democratic gains to older voters becoming increasingly skeptical about persistent Republican claims that Obamacare's Medicare spending cuts have hurt their benefits.

Nevertheless, Republicans have resurrected that line of attack in recent TV ads in Arkansas, Georgia and Iowa. Under the ACA, Medicare spending is projected to decline by $716 billion over 10 years, according to the Congressional Budget Office. But those cuts reduce payments to Medicare Advantage insurers and healthcare providers, while the law actually enhanced beneficiaries' coverage for drugs and preventive services.

Another problem with the GOP attacks is that congressional Republicans also advocate cutting Medicare spending. House Republicans have included those same Medicare spending reductions to improve the program's finances and reduce the federal budget deficit. Robert Moffit, a senior fellow at the conservative Heritage Foundation, argues that such cuts are necessary. “One thing is absolutely certain: You are looking at huge demographic pressures which are going to be hitting Medicare in the next five years,” he said.

But the misleading nature of the GOP charge might not dull its effectiveness as a campaign weapon. “Many older people aren't clear what the ACA did or didn't do,” said Robert Blendon, a Harvard University expert on public attitudes about healthcare. “They just want to be sure you don't change their program. It will matter to them if they think one party or the other is going to do something negative to Medicare or Social Security.”

In their Medicare attacks, Democrats also focus on Ryan's proposal to move future Medicare beneficiaries into private plans under a defined contribution model, potentially exposing seniors to higher out-of-pocket costs. But in the crude parlance of campaign ads, the subtleties of Ryan's proposal are lost.

Rep. Ron Barber (D-Ariz.), facing off against Republican candidate Martha McSally whom he beat by less than 700 votes two years ago, claims in an ad that McSally would “cut Medicare to cut taxes for millionaires.”

That's based on McSally's support for Ryan's House budget blueprint, which would cut taxes for higher-income Americans. The National Republican Congressional Committee has countered with an ad accusing Barber of selling out seniors. The evidence: $716 billion in Medicare cuts under Obamacare.

Last month, Democrats held a rally on Capitol Hill to raise alarms about the GOP agenda on Medicare and Social Security. Dozens of seniors affiliated with labor unions waved signs that read: “Tell the Tea Party: Hands Off My Medicare”—mirroring signs from Tea Party rallies against the Affordable Care Act in 2009. A parade of Democratic legislative leaders, union officials and House members facing tough re-election campaigns took turns speaking.

Rep. Rick Nolan (D-Minn.), whose re-election contest is deemed a “toss-up” by the Cook Political Report, told the crowd: “They want to turn Medicare back over to the insurance companies. We cannot let them do that.” He was followed by Rep. Joe Garcia (D-Fla.), another incumbent in a tight race. “I will never vote to cut Medicare, period,” Garcia said.

Arthur Sanders, a political science professor at Drake University in Des Moines, Iowa, said the stock Medicare attacks block legitimate debate about how to secure the future of Medicare. “The demographics tell us that we're going to have to do something,” he said. “Things would work better if we could actually discuss it in an adult-like way in a campaign.”

Follow Paul Demko on Twitter: @MHPDemko